Fred S Cloninger, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

804 Issued in NC

Practice address

406 S Broad St
Suite a
Gastonia, NC 28054-4304

Phone

(704) 865-3731

Fax

(704) 864-5736

NPI assigned

Sep 21, 2006

Last updated

Oct 2, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fred S Cloninger OD

  dba Broad Street Vision Center

  • Eyewear Supplier
  • Gastonia, NC
  • NPI 1235539099
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222905600000",
    "number": "1508965161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 S BROAD ST",
            "address_2": "SUITE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544304",
            "telephone_number": "704-865-3731",
            "fax_number": "704-864-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 S BROAD ST",
            "address_2": "SUITE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544304",
            "telephone_number": "704-865-3731",
            "fax_number": "704-864-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLONINGER",
        "first_name": "FRED",
        "middle_name": "S",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Standard Cleveland, MD
• Lavy Heng Clevenger, NP
• Paul Michael Clinard, D.D.S.
• Scott Michael Clinard, D.D.S.
• Karen Cline, RDH
• Karen Lynn Cloninger, MD
• Linda Beaty Cloninger, CCS
• Rebecca Elizabeth Clopp, FNP-C
• CMC-Northeast, Inc. (Carolinas Pediatric Neurology Care - Gastonia)
• CMG- Gaston Women's Healthcare LLC

• Optometrist in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.